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Experts want to change the way we talk about obesity.  

Monday, September 26, 2022

Experts want to change the way we talk about obesity and treat this common disease that threatens cardiovascular health.

Obesity misconceptions are common. Many people believe that if people with obesity simply exerted more willpower to eat less and exercise more, they could easily achieve and maintain a healthy, normal weight.

Even people who suffer from obesity may believe this, despite repeated personal experience telling them otherwise. Obesity's rising prevalence — it now affects just over 42 percent of Americans — demonstrates that it is a complex, difficult disease (see "Defining obesity").

Photo by Moe Magners

"Incorrect assumptions and biases about obesity can really derail progress against this problem, which has become the most common chronic disease of our time," says Dr. Fatima Cody Stanford, a Harvard Medical School obesity specialist and associate professor of medicine and pediatrics. Addressing these issues and encouraging people to seek effective treatments can also lower the risk of the numerous, serious health conditions that frequently accompany obesity. Many of these diseases, such as type 2 diabetes, high blood pressure, and sleep apnea, are linked to cardiovascular disease.

Misplaced prejudice

To begin, Dr. Stanford suggests referring to others or yourself as "obese" rather than "obese person." Obesity stigma and bias are widespread, often due to the misconception that poor choices and lack of motivation are the only causes. However, as with many diseases, a number of interconnected factors play a role, according to Dr. Stanford.

The "obesogenic" (obesity-promoting) environment we've all been living in for the past few decades is a major issue. One factor is constant exposure to and easy access to jumbo-sized portions of highly processed foods, which now account for more than half of all food consumed in the United States. These tempting foods, which are high in fat, salt, and sugar, are easy to consume in a hurry — and all those extra calories are frequently stored as fat. Another factor is a lack of physical activity, which makes maintaining a healthy weight more difficult.

What is Obesity?

Obesity is defined as having a body mass index (BMI) of 30 or higher (see /BMI to calculate yours). However, BMI, an indirect estimate of body fat based on height and weight, is not scientific. Many experts believe that measuring the waist circumference is a better way to assess the health risks of excess body fat. A waist circumference of more than 35 inches (in women) or 40 inches (in men) indicates an increased risk.

Other lifestyle and health issues, however, can contribute to weight gain and thwart weight-loss efforts, according to Dr. Stanford. Here are a few of the main culprits:

Insufficiency of sleep Sleep deprivation, particularly six or fewer hours per night, is a well-known contributor to weight gain. While sleep disorders such as insomnia may be to blame, our obsession with screens — computers, smartphones, and television — frequently prevents us from getting enough rest.

Anxiety, depression, and stress These common mental health problems can sap your motivation to exercise and eat healthily. They may also cause emotional eating, which frequently results in overeating high-calorie foods.

Medication on prescription. According to a recent CDC study, one in every five people takes prescription medications that can lead to weight gain. Certain drugs used to treat diabetes, high blood pressure, depression, and muscle pain or inflammation fall into this category.

All of these factors, as well as genetics, influence metabolism, which is controlled by the hypothalamus. This brain region, which controls many bodily functions such as temperature and hunger, also works to keep body weight within a narrow range, or "set point." That means that people who are obese frequently regain the weight they lose—their brains work against them to return to their previous, higher weight, explains Dr. Stanford.

What you are able to do

That is not to say that people who are obese cannot lose weight. However, they frequently require a more nuanced, personalized approach that goes beyond diet and exercise, and may include weight-loss medications or surgery. Dr. Stanford, who works at the Massachusetts General Hospital Weight Center, never recommends specific diets to his patients. Instead, she advises people to focus on eating lean protein, whole grains, fruits, and vegetables, as well as finding their "soul mate" exercise, which they will enjoy doing every day. She also assists them in addressing other lifestyle issues that can affect weight, such as getting enough sleep, treating mental health issues, and substituting weight-loss medications when possible. The Obesity Action Coalition maintains a searchable list of physicians who specialize in treating obesity near you at


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